3T MRI of the Wrist

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Magnetic Resonance Imaging: 3.50
Procedures: 3.50
Musculoskeletal: 3.50

Registered Radiologist Assistant: 2.25
Procedures: 2.25
Musculoskeletal and Endocrine Sections: 2.25

Radiation Therapy: 1.00
Procedures: 1.00
Treatment Sites and Tumors: 1.00

Outline

1. Introduction
2. 3-T MR Imaging Protocol
3. Ligaments and the TFCC
4. Flexor and Extensor Tendons
5. Articular Cartilage
6. Soft-Tissue Masses
7. Bones
8. Nerve Entrapment Syndromes
9. Vascular Lesions
10. Conclusions

Objectives

Upon completion of this course, students will:

1. understand the improvement in the signal-to-noise ratio at 3T versus 1.5T
2. understand the advantages of increased SNR
3. know why contrast resolution is important in the wrist
4. be familiar with coil selection for imaging of the wrist
5. understand strategies for decreasing wrap-around or aliasing
6. know the physiologic artifacts that may affect wrist images
7. be familiar with the field of view (FOV) commonly used for wrist anatomy
8. be able to list the proximal carpal bones in order from lateral to medial
9. be able to list the distal carpal bones in order from lateral to medial
10. define the term “volar” in relation to the wrist
11. understand how ligament tears are categorized
12. know which component of the scapholunate ligament (SLL) is the most functionally important
13. know which component of the scapholunate and lunotriquetral ligaments is involved in degenerative tears
14. understand the causes of wrist instability
15. know the image orientations needed for scapholunate and lunotriquetral ligament evaluation
16. be familiar with the composition of the TFCC
17. list the bones cushioned by the TFCC
18. understand how the TFCC developed
19. be able to identify things that may be mistaken for a tear of the TFCC
20. know which area of the TFCC is avascular
21. be familiar with injuries associated with TFCC tears
22. know the best plane for evaluating the flexor and extensor tendons
23. recognize the normal appearance of the flexor and extensor tendons on MR images
24. be able to define tendinosis
25. understand how laterality of tenosynovitis can help determine its cause
26. recognize tendon tears at 3T
27. describe the appearance of hyaline cartilage on MR images
28. identify the most common soft tissue mass in the wrist
29. recognize the appearance of ganglion cysts on MRI
30. identify which tumors may be found in the median and ulnar nerve sheaths
31. know the definition of thenar and hypothenar eminences
32. know what signal intensity is expected on T2-weighted images of an entrapped nerve
33. know frequent causes of ulnar tunnel syndrome
34. be able to characterize venous malformations
35. compare the MR signal from a hemangioma to that of muscle tissue